Imaging and diagnostic advances for intracranial meningiomas

Abstract

The archetypal imaging characteristics of meningiomas are among the most stereotypic of all central nervous system (CNS) tumors. In the era of plain film and ventriculography, imaging was only performed if a mass was suspected, and their results were more suggestive than definitive. Following more than a century of technological development, we can now rely on imaging to non-invasively diagnose meningioma with great confidence and precisely delineate the locations of these tumors relative to their surrounding structures to inform treatment planning. Asymptomatic meningiomas may be identified and their growth monitored over time; moreover, imaging routinely serves as an essential tool to survey tumor burden at various stages during the course of treatment, thereby providing guidance on their effectiveness or the need for further intervention. Modern radiological techniques are expanding the power of imaging from tumor detection and monitoring to include extraction of biologic information from advanced analysis of radiological parameters. These contemporary approaches have led to promising attempts to predict tumor grade and, in turn, contribute prognostic data. In this supplement article, we review important current and future aspects of imaging in the diagnosis and management of meningioma, including conventional and advanced imaging techniques using CT, MRI, and nuclear medicine.

Fig. 1

(A) Noncontrast CT, (B) T1-weighted gadolinium-enhanced MRI, and (C) T2-weighted MRI of a partially calcified right falcine meningioma.

Fig. 2

(A) Noncontrast CT shows an extra-axial mass with a low-density CSF cleft (arrow) between the mass and adjacent right frontal lobe. (B) MRI T2-weighted image shows an intermediate signal mass with a CSF cleft (arrow). Gadolinium-enhanced MRI in (C) axial and (D) coronal planes demonstrates avid enhancement within the mass and a dural tail sign (arrowhead).

Fig. 3

Noncontrast CT and T1-weighted gadolinium-enhanced MRI demonstrating (A, B) a grade I meningioma with profound hyperostosis and extracalvarial enhancing tumor, and (C, D) a grade III meningioma with lytic erosion of adjacent bone from tumor invasion.

Fig. 4

(A, B) WHO grade I meningioma with diffuse infiltration of bone and occlusion of (C) anterior superior sagittal sinus on angiography and (D) MRV with venous rerouting.

Fig. 5

Dural sarcoidosis mimicking en plaque meningioma. (A, B, C) Gadolinium-enhanced T1-weighted images and (D, E) T2-weighted image show nodular dural thickening and enhancement along the falx and tentorium.